The in-vitro assessment of a collagen/vicryl (polyglactin) composite film together with candidate suture materials for potential use in urinary tract surgery. III. Adherence of bacteria to the material surface

How to explant a diseased liver for living donor liver transplantation after previous gastrectomy with severe adhesion (with video)

We performed living donor liver transplantation (LDLT) in a patient who had undergone distal gastrectomy for gastric ulcer disease with Billroth I reconstruction 30 years before the LDLT. The adhesion was very severe between remnant stomach and hepatic hilum as well as left liver lobe with shortening of hepatoduodenal structures. After dissection of the infrahepatic inferior vena cava, the Spiegel lobe was identified from the dorsal side. The Spiegel lobe was then penetrated with a right angle dissector so that a plastic tape could be placed around the whole adhesion, including important structures in the hepatoduodenal ligament. Next, the right hepatic vein was transected with a vascular stapler using Pringle's maneuver using the plastic tape to fasten the entire adhesional structure. Subsequently, the trunk of the middle and left hepatic vein was transected after clamping. The remaining short hepatic veins in the left side were divided completely from the cranial to the caudal direction to dissect Spiegel's lobe. Finally, the hepatoduodenal ligament was identified from the attached remnant stomach and the duodenum and a vascular clamp was placed on the entire hepatoduaodenal ligament. Finally, the diseased liver was explanted for graft implantation. Thus, retrograde explantation of the liver was effective in decreasing the risk of damaging vital elements in the hepatoduodenal ligament, the remnant stomach, and the duodenum.

Comparison of the breaking strength of polyglactin mesh in urine, serum, and cell culture media

OBJECTIVES

This study was designed to determine the durability of polyglactin woven mesh in various in vitro environments, including urine, since polyglactin 901 mesh has been considered for implementation in urinary tract reconstruction.

METHODS

Segments of 1 x 1-cm sterile woven and knitted polyglactin 910 mesh with and without collagen coating were exposed to the following conditions: dry (at room temperature and at 37 degrees C, humidified air), in porcine and human serum and urine, in porcine urine over a range of pH levels, in infected urine, in cell culture media (MCDB 105 with 5% fetal bovine serum), and in cell culture media with porcine bladder fibroblasts. The mesh breaking strength was measured at 0, 12, 21, 28, and 36 days.

RESULTS

The mean breaking strength for dry, room temperature mesh segments measured 350 g for all time intervals. At day 21, the breaking strength for all mesh types in human and porcine serum, cell culture media, and cell culture media with bladder fibroblasts was less than 10% of the control, but the human and porcine urine maintained 12% to 24% of the control breaking strength (this difference did not reach statistical significance). There was no significant difference in the breaking strength in human and porcine urine or human and porcine serum. By day 38, the breaking strength for all mesh types in all solutions was less than 5% of the control breaking strength. The presence of fibroblasts increased the rate of degradation of the mesh compared with the urine, serum, and cell culture media alone. There was a significant prolongation of degradation with decreasing pH, as well as with infected urine. This prolongation was additive; in fact, all mesh types in low pH (5.0), infected urine showed minimal degradation at 38 days.

CONCLUSIONS

In acidic infected urine, the durability of polyglactin 910 mesh is significantly prolonged compared with the other conditions tested. Therefore, when used in urinary tract reconstruction, as in other organ systems, the integrity of the polyglactin mesh should diminish rapidly after 3 weeks as long as the urine is kept sterile and a neutral to alkaline pH is maintained.

First clinical report of a new biodegradable membrane for use in urological surgery

Following preliminary in vitro and in vivo experiments a new collagen Vicryl mesh has been devised. The membrane has been extensively tested in the laboratory and has been found to resist the passage of urine. It holds sutures well and has been shown on an experimental animal to be biodegradable. The membrane has now been applied in human subjects. It has been particularly efficacious in renal surgery and as a means of sealing a bladder after it has been opened. With respect to the ureter the sealing effect is excellent, to the extent of having produced a urinoma. The membrane has been found to be easily applied in vesicovaginal fistulae but difficulties have been experienced in the presence of infection. It is also an ideal membrane for repair of a urethrovaginal fistula--an area where natural tissues are less easily available. This is the first recorded use of this new biodegradable membrane in the human subject.